DR WINTER – Med Assist Treatment – Suboxone – Addiction – Buprenorphine – CORONAVIRUS update – 208-626-2949

Coronavirus Disease 2019 (COVID-19) Situation Summary

This is an emerging, rapidly evolving situation and CDC will provide updated information as it becomes available, in addition to updated guidance.

Updated February 16, 2020

Background

CDC is closely monitoring an outbreak of respiratory disease caused by a novel (new) coronavirus that was first detected in Wuhan City, Hubei Province, China and which continues to expand. On February 11, 2020, the World Health Organization named the disease coronavirus disease 2019 (abbreviated “COVID-19”).

Chinese health officials have reported tens of thousands of cases of COVID-19 in China, with the virus reportedly spreading from person-to-person in parts of that country. COVID-19 illnesses, most of them associated with travel from Wuhan, also are being reported in a growing number of international locations, including the United States. Some person-to-person spread of this virus outside China has been detected. The United States reported the first confirmed instance of person-to-person spread with this virus on January 30, 2020.

On January 30, 2020, the International Health Regulations Emergency Committee of the World Health Organization declared the outbreak a “public health emergency of international concernexternal icon” (PHEIC). On January 31, 2020, Health and Human Services Secretary Alex M. Azar II declared a public health emergency (PHE) for the United States to aid the nation’s healthcare community in responding to COVID-19. Also on January 31, the President of the United States signed a presidential “Proclamation on Suspension of Entry as Immigrants and Nonimmigrants of Persons who Pose a Risk of Transmitting 2019 Novel Coronavirusexternal icon.” These measures were announced at a press briefing by members of the President’s Coronavirus Task Forceexternal icon.

Coronaviruses are a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people such as with MERS-CoV, SARS-CoV, and now with this new virus (named SARS-CoV-2).

Source and Spread of the Virus

Chinese health officials have reported tens of thousands of cases of COVID-19 in China, with the virus reportedly spreading from person to person in parts of that country. COVID-19 illnesses, most of them associated with travel from Wuhan, also are being reported in a growing number of international locations, including the United States. Some person-to-person spread of this virus outside China has been detected. The United States reported the first confirmed instance of person-to-person spread with this virus on January 30, 2020.

The SARS-CoV-2 virus is a betacoronavirus, like MERS-CoV and SARS-CoV, both of which have their origins in bats. The sequences from U.S. patients are similar to the one that China initially posted, suggesting a likely single, recent emergence of this virus from an animal reservoir.

Early on, many of the patients in the COVID-19 outbreak in Wuhan, China had some link to a large seafood and live animal market, suggesting animal-to-person spread. Later, a growing number of patients reportedly did not have exposure to animal markets, indicating person-to-person spread. Chinese officials report that sustained person-to-person spread in the community is occurring in China. Person-to-person spread has been reported outside China, including in the United States and other countries. Learn what is known about the spread of newly emerged coronaviruses.

Situation in U.S.

Imported cases of COVID-19 in travelers have been detected in the U.S. Person-to-person spread of COVID-19 also has been seen among close contacts of returned travelers from Wuhan, but at this time, this virus is NOT currently spreading in the community in the United States.

The U.S. government has taken unprecedented stepsexternal icon related to travel in response to the growing public health threat posed by this new coronavirus, including suspending entry in the United States of foreign nationals who have visited China within the past 14 days. Measures monitor the health of those who are allowed entry into the United States (U.S. citizens, residents and family) who have been in China within 14 days also are being implemented.

Illness Severity

Both MERS and SARS have been known to cause severe illness in people. The complete clinical picture with regard to COVID-19 is not fully understood. Reported illnesses have ranged from mild to severe, including resulting in death. Learn more about the symptoms associated with COVID-19.

There are ongoing investigations to learn more. This is a rapidly evolving situation and information will be updated as it becomes available.

Risk Assessment

Outbreaks of novel virus infections among people are always of public health concern. The risk from these outbreaks depends on characteristics of the virus, including how well it spreads between people, the severity of resulting illness, and the medical or other measures available to control the impact of the virus (for example, vaccine or treatment medications).

The potential public health threat posed by COVID-19 is high, both globally and to the United States. The fact that this disease has caused illness, including illness resulting in death, and sustained person-to-person spread in China is concerning. These factors meet two of the criteria of a pandemic. It’s unclear how the situation will unfold, but risk is dependent on exposure. At this time, some people will have an increased risk of infection, for example healthcare workers caring for patients with COVID-19 and other close contacts of patients with COVID-19. For the general American public, who are unlikely to be exposed to this virus, the immediate health risk from COVID-19 is considered low at this time.

What to Expect

More cases are likely to be identified in the coming days, including more cases in the United States. It’s also likely that person-to-person spread will continue to occur, including in the United States.

CDC Response

This is a picture of CDC’s laboratory test kit for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). CDC is shipping the test kits to laboratories CDC has designated as qualified, including U.S. state and local public health laboratories, Department of Defense (DOD) laboratories and select international laboratories. The test kits are bolstering global laboratory capacity for detecting SARS-CoV-2.

This is a picture of CDC’s laboratory test kit for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). CDC is shipping the test kits to laboratories CDC has designated as qualified, including U.S. state and local public health laboratories, Department of Defense (DOD) laboratories and select international laboratories. The test kits are bolstering global laboratory capacity for detecting SARS-CoV-2.

  • The federal government is working closely with state, local, tribal, and territorial partners, as well as public health partners, to respond to this public health threat.
  • The public health response is multi-layered, with the goal of detecting and minimizing introductions of this virus in the United States so as to reduce the spread and the impact of this virus.
  • CDC established a COVID-19 Incident Management System on January 7, 2020. On January 21, 2020, CDC activated its Emergency Operations Center to better provide ongoing support to the COVID-19 response.
  • On January 27, 2020, CDC issued updated travel guidance for China, recommending that travelers avoid all nonessential travel to all of the country (Level 3 Travel Health Notice).
  • The U.S. government has taken unprecedented steps with respect to travel in response to the growing public health threat posed by this new coronavirus:
  • CDC issued an interim Health Alert Network (HAN) Update to inform state and local health departments and healthcare professionals about this outbreak on February 1, 2020.
  • On January 30, 2020, CDC published guidance for healthcare professionals on the clinical care of  COVID-19 patients.
  • On February 3, 2020, CDC posted guidance for assessing the potential risk for various exposures to COVID-19 and managing those people appropriately.
  • CDC has deployed multidisciplinary teams to support state health departments with clinical management, contact tracing, and communications.
  • CDC has worked with the Department of State, supporting the safe return of Americans who have been stranded as a result of the ongoing outbreaks of COVID-19 and related travel restrictions. CDC has worked to assess the health of passengers as they return to the United States and provided continued daily monitoring of people who are quarantined.
  • CDC has developed a real time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) test that can diagnose COVID-19 in respiratory samples from clinical specimens. On January 24, 2020, CDC publicly posted the assay protocol for this test.
  • CDC has been uploading the entire genome of the viruses from reported cases in the United States to GenBank as sequencing was completed.
  • CDC has grown the COVID-19 virus in cell culture, which is necessary for further studies, including for additional genetic characterization. The cell-grown virus was sent to NIH’s BEI Resources Repositoryexternal icon for use by the broad scientific community.

CDC Recommends

  • While the immediate risk of this new virus to the American public is believed to be low at this time, everyone can do their part to help us respond to this emerging public health threat:
    • It’s currently flu and respiratory disease season and CDC recommends getting a flu vaccine, taking everyday preventive actions to help stop the spread of germs, and taking flu antivirals if prescribed.
    • If you are a healthcare provider, be on the look-out for people who recently traveled from China and have fever and respiratory symptoms.
    • If you are a healthcare provider caring for a COVID-19 patient or a public health responder, please take care of yourself and follow recommended infection control procedures.
    • If you have been in China or have been exposed to someone sick with COVID-19 in the last 14 days, you will face some limitations on your movement and activity. Please follow instructions during this time. Your cooperation is integral to the ongoing public health response to try to slow spread of this virus. If you develop COVID-19 symptoms, contact your healthcare provider, and tell them about your symptoms and your travel or exposure to a COVID-19 patient.
    • For people who are ill with COVID-19, please follow CDC guidance on how to reduce the risk of spreading your illness to others.

DR WINTER – MEDICATION ASSISTED TREATMENT – OPIOID OPIATE ADDICTION – POST FALLS ID

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PHYSICIAN LEVEL SERVICE

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OPIOID and opiate abuse/addiction medication assisted treatment (MAT) with Suboxone, Buprenorphine, Subutex.  PHYSICIAN level service.  PRIVATE.  Successful integration into daily life without fear and guilt.  START TODAY.

ADDICTION – ABUSE – OVERUSE – OPIOIDS – SUBOXONE(R) – BUPRENORPHINE – CALL 208-626-2949 WHY WAIT ANY LONGER? Dr Winter POST FALLS

CALL ME…..

208-626-2949

WHY WAIT?

BUPRENORPHINE – Subutex(R) – Suboxone(R) – MAT TREATMENT – CALL 208-626-2949 – Dr Winter POST FALLS ID

  • OPIATE OVERUSE OR ADDICTION USE – buprenorphine
  • PRIVATE
  • PERSONAL
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  • PROFESSIONAL
  • CALL ME.  208-626-2949

OPIOID/OPIATE CLINIC – MED ASSISTED TREATMENT – CALL 208-626-2949 – Dr Winter POST FALLS ID

Information about Medication-Assisted Treatment (MAT)

 

Medication-assisted treatment (MAT) is the use of medications in combination with counseling and behavioral therapies, which is effective in the treatment of opioid use disorders (OUD) and can help some people to sustain recovery.

More must be done to facilitate treatment options and the development of therapies to address OUD as a chronic disease with long-lasting effects. This means helping more people secure MAT, which requires us to break the stigma often associated with some of the medications used to treat OUD. It also requires us to find new and more effective ways to advance the use of medical therapy for the treatment of OUD.

There are three drugs approved by the FDA for the treatment of opioid dependence: buprenorphine, methadone, and naltrexone. All three of these treatments have been demonstrated to be safe and effective in combination with counseling and psychosocial support. Everyone who seeks treatment for an OUD should be offered access to all three options as this allows providers to work with patients to select the treatment best suited to an individual’s needs. Due to the chronic nature of OUD, the need for continuing MAT should be re‐evaluated periodically. There is no maximum recommended duration of maintenance treatment, and for some patients, treatment may continue indefinitely.

FDA-approved buprenorphine products approved for the treatment of opioid dependence include:

Bunavail (buprenorphine and naloxone) buccal film
Cassipa (buprenorphine and naloxone) sublingual film
Probuphine (buprenorphine) implant for subdermal administration
Sublocade (buprenorphine extended‐release) injection for subcutaneous use
Suboxone (buprenorphine and naloxone) sublingual film for sublingual or buccal use, or sublingual tablet.
Subutex (buprenorphine) sublingual tablet
Zubsolv (buprenorphine and naloxone) sublingual tablets

FDA-approved methadone products approved for the treatment of opioid dependence include:

Dolophine (methadone hydrochloride) tablets
Methadose (methadone hydrochloride) oral concentrate

FDA-approved naltrexone products approved for the treatment of opioid dependence include:

Vivitrol (naltrexone for extended-release injectable suspension) intramuscular

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Emergency Poetry

POETRY BY DRJPWINTER

****************************************************************

TO SEASONS OF COEUR

drjpwinter

As young love brilliance faded,
Storms of passion now jaded –
As friendship salvage tenets stated,
Love and the spirit must be traded.

*****

“TO FAMILIES OF EMERGENCIES”

drjpwwinter

Harmony or storms

Riding life’s ocean waves –

With dangerous sneaker forms

Which always, love saves.

*****

“TO EMERGENCIES BONDING”

jpwinter

Nature’s bucky balls fly

In cosmos carbon flight –

Not to any naked eye

Bonds of absolute might.

*****

“TO THE CALL – STAT, STAT, STAT”

drjpwinter

ER team looks for life’s sign

DOA, Trauma Red and Code Blue –

Emergency calls define

As malpractice and lawyers ensue.

*****

TO FAVORITE DAUGHTERS

drjpwinter

One never knows of  love

As depth of breaths recede –

And graceful prayer rains from above,

A newborn rainbow when dark clouds preceed.

*****

“TO THE SEASONALLY EMERGENT”

drjpwinter

Winter wonderland

Spring wildflower in hand –

Summer parade band

Fall colors in ocean sand.

*****

“TO MY MENTOR MRYUK”

drjpwinter

Wizard to honor

Comrade to hail –

Physician of poisons

Career sunset sail.

“DRUGS’ HALL OF SHAME” – IT’S NOT ABOUT PERFORMANCE

DRUGS…PROFIT…PERFORMANCE…DRUGS…CHEAT…ILLICIT…UNETHICAL…

PROFIT…

PERFORMANCE…CHEAT…ABUSE…LIE…DIE

So much of our world is drug oriented. We understand overall, that without drugs, even chemicals, our world would be full of disease, food sources would be lessened, and conveniences would be limited. As this thesis is written, the touch is embracing plastic keys, rubberized mouse pads, vinyl coated wiring – my elbows pushing steadily on laminate. The rubber tips of my work tools include rubber ear tips on my stethoscope, rubberized tubing to the metal plated bell to listen to patients’ hearts with a plastic cover shield to clean off.

So what is the deal with the lead in the toys? The recent recall included over 405,000 lead contaminate toys from the Chinese manufacturers. Some of the toys recalled were “Duck Family,” Robot 2000, Big Red Wagons, Winnie-the-Pooh spinning products.

To my knowledge, no child has been severely poisoned with these toys, nor injured in a poisoning sense with these lead toys. The greatest majority of lead cases these days are from old paints…pre-1976…when lead was taken out of the USA marketplace of paints. So old paint chips that children eat or ate, especially in older home and apartment buildings renovations, was and are the source. But the biggest reduction in lead overall in the USA was the reduction of lead in gasoline. This essentially stopped the big problem. More discussion of lead poisoning was when under Clinton’s administration, the lead limits were reduced to an absolute low level despite little or no data to support the new change. But even with this new limit in children, few ever have had disease.

Nicotine in itself is a drug, a chemical that has been used obviously in smoking addiction, but in itself is not a bad thing. It has been used in industry in a variety of compounds. Nicotine, however, is the buzz in smoking. Just good old craziness allowed the U.S. to create multi-millionaire attorneys fighting for “our rights” and for those who “didn’t know” cigarettes were bad, yet the USA funds tobacco, the tribes sell tobaccos at reduced prices to entice smoking, and the CDC funds research to explore “the nicotine drug cure,” and it is all still legal. At a recent American Heart Association meeting, research on the new nicotine vaccine has made some promising head roads. One year and five shots later, the vaccine doubled the number of “stopped” addicted smokers from about 6% to 15% over the year. The problem still exists that less than 10%, some say lower, smokers of cigarettes ever stop that consistently try to stop. How many smokers? About 46-50 million in the U.S. and about half of them will try to stop sometime. The vaccine is a potentially great drug to help. The nicotine blocker med which castMD has written on before still helps to, but so far is not necessarily more effective than the patch or the gum. Stopping smoking takes good old will power.

And then there is the date-rape drugged toys. Most of this happened if not all was with the “Aqua Dots” toys. It seems that one of the chemicals in the surrounding coating changes or gets metabolized in the body when eaten. This is an extremely unique and interesting mass-market finding. It is really quite amazing that it was found. The GHB that was found is extremely difficult to measure generally. Many times in the ER, labs can not find it. It is metabolized quickly. Some of the previous day’s internet drug providers (illicit) sold chemicals that would convert to GHB. Some of these chemicals are still passed around and used at “rave parties” and other parties. GHB is a dangerous drug. It is illicit. It can kill you or make you unable to defend, protect, or interact. Thusly, called the date-rate drug. However, it was a prescription drug known as Rohypnol that was one of the original date rape drugs. It is also now illegal in the U.S., but probably can be found in the international markets illegally…not sure of legally however. Always open your own beverage and never leave one sitting around…especially in the club scene.

Did Bonds do it or not? Will the “asterisked” marked Hall of Fame baseball be delegated a fraud by another drug story? Not just another drug related story in recent and past news. Maybe all steroids should just be allowed in all athletics. Tell the athletes the risk, the wrestlers, the baseball players, and the Olympians. All these steroid abuse stories have hit the news just in the past months.

But the problem with that is…this story…

Doping in sports is a problem. But would you give or have someone else give your daughter or son steroids for performance enhancement? Watching little league and junior to senior sports makes me wonder. How far would a parent or caregiver go?

From the 1976 Olympians of East German come the latest stories of abuse, which is being called in a new documentary “The Great Olympic Drug Scandal: Revealed.” The sports “theme plan” developed relied on anabolic steroids. That year, 40 gold medals were placed over East Germany’s team members with a heavy emphasis on women’s swimming events winning all the golds in nearly all the events. Children were given oral tablets and injections, even on the day of competition in the Olympics, untraceable at that time. Coaches were rewarded by success, despite the unethical mark. Some athletes recruited prior to teenage were started on performance enhancement drugs. Doctors were required to sign confidentiality agreements despite the unethical mark.

Some of the athletes had sexual identity and self-worth problems while growing up. Many had obvious gynecological irregularities. In later life, sexual identity was explored and some even had sex changes. But many have been left out of the story lines…How has their lives been altered? How many have died unknown, changed forever by the decay of human value, gross ethical breaches of doctors, and limitless greed of self-flagellating coaches.

Systematic. Documented in abusive performance. Involuntary. Organized to destroy human life. Sidelined by death. Welcome to professional sports and Olympian sports.

Welcome to Beijing anyone?

Welcome to the Drugs’ Hall of Shame! It is NOT about performance…

Cocaine – Hydros – Weed – “The Three Amigos” in the Workplace

Workplace drug tests recently have shown a decrease in cocaine positives during the first half of 2007. The positive tests for cocaine dropped 16% as the overall rate was 0.58 percent. This rate is the lowest since tracking the information back in 1997 by one lab. The lowest rate of decline was in the Midwest while the highest rate of decline was in the New England areas. The total tests counted for this tracking included about four and one-half million urine drug tests, which all included testing for cocaine and other drugs of abuse. Some believe the shortage of cocaine and higher costs are driving the decline, while European cocaine abuse is becoming increasingly popular, adding to world-wide demand. As a Medical Review Officer for Work-Place Drug Testing, cocaine remains popular.

In another report on drugs of abuse, marijuana recently was highlighted. It is apparent that reefing the great weed is about 5 times more harmful than one cigarette. The apparent problem is a greater intensity of airway obstruction. This effect may be caused by an increased “holding” of the smoke which is a longer time of interaction with the lung tissue. Another concept is that the smoke is literally hotter, creating a deeper thermal injury to the lung tissue itself. Interestingly, when compared to regular smokers, the marijuana smokers had less emphysema changes.

DAWN, or the Drug Abuse Warning Network, continues to focus on hydrocodone. This narcotic goes with the brand names of Norco, Lortab, Vicodin – but is generic in many prescriptions. Sales of hydrocodone and oxycodone have dramatically increased over the past years. The Pharma industry spends over 3 times as much on advertising as it did a decade ago.

www.castMD.com has written on this plague and the advertising push to addiction by the Pharma industry in past postings.

Despite the pressure to put these dangerous and addictive drugs on a higher schedule of restriction of prescribing, Schedule II, the FDA and DEA has been lobbied heavily to not do so.

With all the Pharma advertising, a push toward better pain management, and the abuse of narcotics, hydrocodone based drugs and combo drugs ranked number 2 in 2006 just behind the cholesterol lowering brand name, Lipitor. From 2001 to 2006, hydrocodone prescriptions rose by 2/3rds.

Hydrocodone is the number one drug in its category to arrive at the Emergency Department. It is also the number one drug of its category reported to the National Forensic Lab Info System.

www.castMD.com says, “Ban hydrocodone or elevate the Schedule.” It is a considerable concern of abuse in junior high kids, high school kids, and patients.”    Should it be banned?

adapted:  acoem/castMD

Is your doctor getting old? Ask the mature doctor if:

Does the doctor know that doctors and nurses wrote on the same non-electronic paper?

Does your doctor know that intravenous solutions came in glass, as well as “shots” – bottles like milk?

Does your doctor know that bedpans were steel and cold?

Does your doctor know that the coroner and funeral director and the ambulance driver were all the same guy?

Does your doctor know that appendix can come out without a catscan?

Does your doctor know that defibrillators were once very big devices and heavy?

Does your doctor reminisce when nurses got up to let the doctor sit down?

Does your doctor remember the times of routine housecalls?

Does your doctor know the Rat Pak is not a surgical dressing?

Does your doctor know the ER was not manned 24/7?

Does your doctor know that a wet xray reading was actually wet?

Does your doctor know listening to patients is a good thing?

adapted with additional content from EPM and castMD.com

Bitnami